The Physiological Basis of Acute GFR Decline With Renoprotective Therapies

The authors investigate the physiological basis for the acute decline in estimated glomerular filtration rate (eGFR) observed with renoprotective therapies, such as RAS inhibitors and SGLT2 inhibitors, which paradoxically correlate with long-term kidney protection. They explain that this decline is a hemodynamic response resulting from reduced glomerular capillary pressure, rather than nephrotoxicity, and detail the mechanisms by which these therapies regulate intraglomerular pressure. Ultimately, the review aims to clarify how these treatments can initially impair eGFR while promoting renal health in the long term.